If you’ve been wondering: does insurance cover rehab? We’ve got answers.
If you or a loved one is struggling with drug or alcohol addiction, addiction rehab centers offers you the best chance at long-term recovery. As with any medical treatment, addiction rehabs can be costly, so you are probably hoping your insurance will cover at least a portion of the expenses. The simple answer to the question, “Does insurance cover rehab,” is yes, it does, but the practical answer is a bit more complicated. In 2014, key provisions of the Affordable Care Act (commonly known as “Obamacare”) became active that affected insurance coverage for substance abuse treatment. Mental health and substance abuse coverage are now considered essential health benefits, but that doesn’t guarantee that your insurance will pay for the treatment that gives you the best chance at recovery. It is important to find out what your specific insurance plan will cover before you enter into rehab so you are not left with medical bills you cannot afford.
Factors that can affect your rehab coverage
If you have obtained your insurance through one of the ACA marketplaces, then you have health insurance that covers substance abuse. How complete that coverage is, and how much of your substance abuse treatment you will have to pay for yourself, is affected by several factors. Your specific rehab coverage will be determined by the state you reside in and the health plan you choose. Different plans will vary in several respects, including the following:
Before 2014, insurers could deny paying for treatment for pre-existing conditions. Many insurance companies applied this rule to drug and alcohol treatment, determining that anyone who had ever gotten counseling or treatment for substance abuse in the past who was suffering a relapse came under the pre-existing statute. That doesn’t apply now; even if you are suffering a relapse from recent treatment, your treatment can be covered, provided that you are within other guidelines for treatment coverage.
Addiction treatment insurance coverage includes strict guidelines on how many days of treatment are covered, as well as the number of visits. If you have recently attended rehab, you may have already met your maximum number of mental health / substance abuse visits and exhausted your coverage for the year.
Deductibles and co-pays
The addiction treatment insurance coverage you have will specify a yearly deductible and out-of-pocket amount that must be met before your insurance pays for care. If you have a high deductible, the addiction treatment center may allow you to set up a payment plan to meet your costs.
Inpatient vs. outpatient care
Addiction treatment insurance coverage typically provides for a combination of inpatient and outpatient therapy. While both types of therapy are effective, inpatient rehab provides the opportunity to focus more fully on recovery. Inpatient rehab is substantially more expensive, as it involves 24-hour care and intensive therapy in a residential setting. Outpatient care involves individual sessions so it can be more easily shaped to meet your particular needs and budget.
Depending on the insurance coverage you have, you may be required to undergo a Pre-Authorization process before getting approval to enter rehab. This can be a lengthy process that the treatment center will have to be involved with, as the intensive approval process requires answers about diagnosis and treatment and may include a peer-to-peer review. The insurance carrier may also specify that you can only seek care from physicians who are in your network.
Types of therapies
Some insurance plans have strict guidelines on the types of treatments that they are willing to pay for. Many insist on evidence-based treatments such as behavioral therapy. If the addiction rehab center you choose relies more on holistic treatments like acupuncture that do not have a proven track record for helping to overcome addiction, the insurance company may not cover the cost.
If your insurance company will not cover rehab at the addiction center you choose, don’t despair. There are many accredited addiction rehab centers from which to choose. You should be able to find one that provides the treatment that will give you the best chance at recovery and is willing to work with you so you can self-pay for any amount of treatment your insurance does not cover.